{"npi":"1659386258","type":"NPI-2","status":"active","name":{"display":"Deris Pharmacy INC","other":[],"organization_name":"DERIS PHARMACY INC","authorised_official":"Gennadiy Abdurakhmanov"},"specialty":{"primary_taxonomy":"3336C0003X","primary_taxonomy_description":"Community/Retail Pharmacy","slug":"community-retail-pharmacy","schema_org_specialty":null,"all":[{"code":"332B00000X","description":"Durable Medical Equipment & Medical Supplies","primary":false,"state":null,"license":null},{"code":"333600000X","description":"Pharmacy","primary":false,"state":null,"license":null},{"code":"3336C0003X","description":"Community/Retail Pharmacy","primary":true,"state":"NY","license":"020200"}]},"addresses":[{"purpose":"LOCATION","street_1":"4748 BELL BLVD","city":"BAYSIDE","state":"NY","postal_code":"113613334","country_code":"US","phone":"7182292344","fax":"7187170004"},{"purpose":"MAILING","street_1":"4748 BELL BLVD","city":"BAYSIDE","state":"NY","postal_code":"113613334","country_code":"US","phone":"7182292344","fax":"7187170004"}],"license":{"state":"NY","number":"020200"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"01126154","state":"NY","issuer":null},{"type_code":"01","label":"Other","value":"2066412","state":null,"issuer":"PK"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20100930079250","type_code":"30-A5","type_desc":"DME SUPPLIER - PHARMACY","state":"NY","pac_id":"9234258617"},{"enrlmt_id":"O20210401001225","type_code":"12-73","type_desc":"PART B SUPPLIER - MASS IMMUNIZATION (ROSTER BILLER ONLY)","state":"NY","pac_id":"9234258617"}]},"enumeration_date":"2006-07-30","last_updated":"2026-04-16","_meta":{"source":"NPPES","snapshot_date":"2026-04-16","doc_url":"https://findmynpi.com/api"}}